AB1618 OUTCOMES OF HEPATITIS B AND TUBERCULOSIS SCREENING IN A COHORT OF PATIENTS ON BIOLOGIC DISEASE-MODIFYING ANTI-RHEUMATIC DRUGS (bDMARDS) FOR RHEUMATIC DISEASE AT A MELBOURNE PUBLIC HOSPITAL
Authors: H. Pourhadi, A. Johnson, A. Foote
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Screening for hepatitis B and tuberculosis is recommended prior to the commencement of biologic disease modifying anti-rheumatic drugs <sup>[1]</sup>. However, in routine clinical practice this can easily be overlooked, sometimes with severe consequences. <h3>Objectives</h3> We aimed to identify the percentage of patients screened for hepatitis B and tuberculosis prior to the commencement of bDMARDs in our rheumatology patients. We also determined if immunisation to hepatitis B was discussed in those with no serological evidence of immunity to the disease, and whether individuals with positive quantiferon gold (QTB) serology were referred for treatment prior to commencing bDMARDs. <h3>Methods</h3> All current rheumatology patients on bDMARDs at the Northern Hospital in Epping, Melbourne Australia were included in this study. By retrospectively reviewing the medical records, data was collected regarding patient demographics, clinical information and pre-treatment screening results including hepatitis B and QTB serology. Ethics committee approval was sought from our institution (Reference number: ALR 63.2020). <h3>Results</h3> There were 138 patients on bDMARD included in this analysis. 97 (70%) were female with a mean age of 51 (SD +/-15) at the time treatment was commenced. Rheumatoid arthritis was the most common indication for biologic therapy (67%) followed by ankylosing spondylitis (15%) and psoriatic arthritis (14%). Tumour necrosis factor inhibitors (TNFi) and Janus kinase inhibitors (JAKi) were most often utilised, prescribed to 72% and 13% of patients respectively. Prior to commencing bDMARDs, 128 (92%) patients were screened for hepatitis B infection. All of these individuals had hepatitis B surface-antigen (HBsAg) tested; 106 (76%) had Hepatitis B surface-antibody (HBsAb) tested and 92 (67%) had hepatitis B core antibody (HBcAb) tested. Among patients screened, 33 (25%) demonstrated immunity to hepatitis B either by previous infection (6%) or vaccination (19%), 1 (1%) were positive for HBsAg and 100 (75%) were susceptible to infection. Of these susceptible individuals, one (1%) was advised to have the hepatitis B vaccinations prior to commencing bDMARDs. Screening for tuberculosis with QTB serology was performed in 125 (90%) patients. Seven (5%) had a positive result and three (2%) were indeterminate. All patients with positive QTB results were referred to infectious diseases for treatment. <h3>Conclusion</h3> Patient demographics such as age, sex and indication for biologic therapy were similar to other bDMARD registries. Pre-treatment screening for hepatitis B was undertaken in most patients and demonstrated a significant number of non-immune individuals. Counselling on the importance of vaccination prior to commencing bDMARDs was rarely documented. There is a need for further counselling on the importance of immunisations in patients on bDMARDs and better access to vaccinations in public hospital rheumatology clinics. <h3>Reference</h3> [1] Fragoulis GE, Nikiphorou E, Dey M, et al2022 EULAR recommendations for screening and prophylaxis of chronic and opportunistic infections in adults with autoimmune inflammatory rheumatic diseasesAnnals of the Rheumatic Diseases Published Online First: 03 November 2022. doi: 10.1136/ard-2022-223335 <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.